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One Surgeon's Experience with a Low-Opioid Postoperative Pain Protocol for Foot and Ankle Surgery
Thomas M Ehlers1, Kevin Blue1, Dustin L Kruse1
1*Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO.
Journal of the American Podiatric Medical Association
|June 26, 2025
Summary
A new low-opioid pain protocol for foot and ankle surgery significantly reduced opioid use. This approach, using ibuprofen and acetaminophen, offers a viable alternative to traditional opioid prescriptions.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Pharmacology
Background:
- The United States faces a severe opioid epidemic, with over 80,000 deaths in 2021.
- Limited research exists on multimodal, low-opioid postoperative pain protocols in foot and ankle surgery.
Purpose of the Study:
- To evaluate a novel low-opioid postoperative pain protocol for foot and ankle surgery patients.
- To assess the efficacy and opioid burden of this new protocol compared to traditional methods.
Main Methods:
- A retrospective review of 20 patients undergoing foot and ankle surgery.
- Patients received ibuprofen (400 mg) and acetaminophen (1,000 mg) every 6 hours, with 15 mg morphine sulfate for breakthrough pain.
Main Results:
- The average morphine milliequivalents consumed was 27.75.
- Patients took an average of 1.85 (15 mg) morphine sulfate tablets.
- Average Visual Analog Scale pain scores were 5.40 (day 3), 4.50 (day 5), and 2.25 (day 7).
Conclusions:
- The study suggests potential overprescription of opioids in foot and ankle surgery.
- A multimodal low-opioid protocol can effectively manage pain with a reduced opioid burden.
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